"We must be ready to dare all for our country. For history does not long entrust the care of freedom to the weak or the timid. We must acquire proficiency in defense and display stamina in purpose." - President Eisenhower, First Inaugural Address

A new study from researchers with the Harvard Medical School found that 45,000 deaths a year can be attributed to the lack of health insurance. Our readers ask: Really? And, they want to know, isn’t this finding actually from the single-payer advocacy group Physicians for a National Health Program?***The 45,000 deaths figure became the basis for an eye-catching billboard from the Health Care for America Education Fund, a group associated with Health Care for America NOW, a coalition of liberal and union groups backing health care overhaul efforts.

Now, on to the tough question: Is the 45,000 figure accurate? We can’t say for sure, but scores of other studies also conclude that persons without health insurance have a higher chance of dying prematurely than those with health insurance. A committee headed by Dr. John Z. Ayanian of the National Academies’ Institute of Medicine reviewed nearly 100 such studies released since 2002. And in March he summed up the findings for Congress this way:

Ayanian’s testimony to Congress, March 2009: Uninsured Americans frequently delay or forgo doctors’ visits, prescription medications, and other effective treatments, even when they have serious disease or life-threatening conditions. … Because uninsured adults seek health care less often than insured adults, they are often unaware of health problems such as high blood pressure, high cholesterol, or early-stage cancer. Uninsured adults are also much less likely to receive vaccinations, cancer screening services such as mammography and colonoscopy, and other effective preventive services.

***There has been some criticism of this type of research and its ability to find a direct causal link. A 2003 commentary by Richard Kronick in Medical Care Research and Review questioned whether other factors beyond uninsurance would reduce the greater mortality for the uninsured. Kronick recreated the Franks study using more recent data and, after adjusting for various factors, also found a 25 percent greater risk of death for the uninsured. But he said: "It seems likely that if we were able to control for additional factors, such as health-related behaviors (smoking, alcohol consumption, obesity, and risk-taking behaviors more generally), wealth, or value placed on health or health care, the estimated effect of being uninsured would be reduced further. What is uncertain is whether the reduction would bring the estimated hazard ratio all the way down to 1.0 or whether an independent effect of being uninsured would remain." (Other studies, including the Franks study, did adjust for smoking, alcohol consumption, obesity and income.)

Another recent report, written by former Congressional Budget Office Director June O’Neill and her husband, economist Dave O’Neill, said "that lack of health insurance is not likely to be the major factor causing higher mortality rates among the uninsured. The uninsured — particularly the involuntarily uninsured — have multiple disadvantages that in themselves are associated with poor health." Those disadvantages include education level and income. The O’Neills’ study, published by the conservative Employment Policies Institute, separated those it deemed "voluntarily uninsured" (anyone earning 2.5 times the poverty level) from those considered to be "involuntarily uninsured." The study looked at data on persons aged 51 to 61 from the Health and Retirement Survey and determined the "involuntarily uninsured" had an 11 percent higher probability of dying; the number dropped to 3 percent when controlling for smoking as well as education and income. The “voluntarily uninsured” had a 2 percent to 3 percent greater probability of dying. EPI, the publisher of the study, supports business interests and has said that the “living wage campaign” is “an organized effort to force employees to inject a welfare mentality into the workplace.”

In fact, the range of studies puts the "death from lack of insurance" level from 18,000 to the 45,000 level.

Well, who makes up the "uninsured?" Not the very poor - they have access to Medicaid. Not the over 64 crowd, they have Medicare. Not veterans, they have the VA. But we have the answer:

We may be accustomed to thinking of the uninsured as low-income individuals and struggling families. But the Census Bureau data show that many are relatively affluent. Over 17.5 million -- 38 percent -- of the uninsured make more than $50,000 a year. And 9.1 million have an annual income of over $75,000 a year.

How can this be? In part, it's because a number of financially comfortable young Americans choose not to purchase health insurance. Known in the healthcare trade as the "invincibles" -- because they’re so sure they won't get sick -- these young singles would rather keep their money than shell out for expensive monthly insurance premiums because of the many mandates and regulations place on insurers by the states.

This intentional avoidance of health insurance is quite common. According to the Commonwealth Fund, Americans age 19-29 comprise one of the largest and fastest-growing segments of the uninsured population.

If the fact that over a third of the uninsured are pulling down more than $50,000 a year isn’t shocking enough, how about this: Nearly 10 million uninsured aren't even U.S. citizens!

It's certainly unfortunate that these individuals don't have health insurance, of course. But they can still get free treatment in emergency rooms. And even a fully nationalized healthcare system would be unlikely to provide them with health insurance.

Another 14 million of the uninsured are fully eligible for government assistance through programs like Medicare, Medicaid, and SCHIP.

How does that break down? A 2008 study by the Georgetown University Health Policy Institute showed that a whopping 70 percent of uninsured children are eligible for Medicaid, SCHIP, or both programs. And roughly 27 percent of non-elderly Americans who are eligible for Medicaid haven’t enrolled and simply live their lives without health insurance, according to the Urban Institute.

Is it really fair to say that such individuals don’t have health insurance? Further, if millions of Americans aren't availing themselves of taxpayer-funded coverage, why should we think that an even bigger government healthcare bureaucracy would solve the problem?

Of course, there are people who really do fall through the cracks. These are the chronically uninsured -- the working poor. They are people who struggle to hold down jobs and support their families. They earn less than $50,000 per year but too much to qualify for government help. They simply can’t afford insurance.

There are roughly 8 million of these chronically uninsured. Any attempt to solve the problem of the uninsured should focus on this narrow slice of the 45.7 million person pie.

So, now the question must be asked. Which group of the "uninsured" is driving the higher mortality rate for uninsureds? Well, I am still working that out, but I did find this study which may help explain some things:

In 2003, the three leading causes of death in King County were cancer, heart disease, and stroke. The leading causes of death differed in different age groups (data not shown). In general, unintentional injury, cancer, homicide, and suicide ranked higher among the younger age groups while heart disease, cancer, and other chronic diseases ranked higher among the older age groups. AIDS went from being the number one killer among males age 25-44 in 1996 to number four in 2003, and number five for both males and females.

The leading causes of death also varied among the racial/ethnic groups. In general, unintentional injury, homicide,and diabetes ranked relatively higher among the minority populations. Conditions of the perinatal period were the ninth leading cause of death for African Americans and the sixth for Hispanic/Latinos.

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EagleSpeak

About EagleSpeak

The main focus of this blog is maritime security. Other matters may appear. I am a retired attorney and a retired Navy Reserve Captain (Surface Warfare). Opinions expressed herein are my own. Sometimes I have the experience to back them up. Your opinions may vary. Don't panic. Feel free to disagree, that's what free speech is all about.
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Under the header: An F/A-18E of "Golden Warriors" VFA 87 lands on the flight deck of USS George H.W. Bush (CVN 77). (U.S. Navy photo by PO3 Christopher Gaines/Released)